Authors (including presenting author) :
Chan ATP (1), Wai TH(1), Lam MK(1), Ma MKM(1).
Affiliation :
(1) Renal Unit, Queen Mary Hospital.
Introduction :
During the COVID-19 pandemic, there was a marked rise in demand for acute haemodialysis among patients with chronic kidney disease (CKD), as many progressed to end-stage kidney disease (ESKD) requiring peritoneal dialysis (PD). To address this, a nephrologist-led fluoroscopic-guided PD catheter placement programme was introduced in January 2022 as a sustainable alternative to traditional surgical catheter placement.
Objectives :
This study aims to:
1. Compare complications and catheter survival rates in fluoroscopic-guided PD catheter placement versus other methods.
2. Assess the program's impact on the number of acute haemodialysis sessions required before PD catheter placement, pre-and post-implementation.
Methodology :
Patients undergoing PD catheter placement via fluoroscopic guidance, nephrologist mini-laparotomy, urologist mini-laparotomy, or laparoscopic placement were included. The outcomes analysed were:
• Operating time.
• Procedure-related complications (e.g., catheter leaks, exit site bleeding, catheter dysfunction).
• Catheter survival at 180 and 365 days.
• Number of acute haemodialysis sessions before PD catheter placement.
Comparisons were made to evaluate the fluoroscopic-guided programme's impact on clinical outcomes and service efficiency.
Result & Outcome :
From January 2022 to December 2024, 172 catheters were placed (63% male, 37% female, average age 64.1 years). Of these, 76 were fluoroscopic-guided placements with an average operating time of 51.1 minutes, compared to nephrologist mini-laparotomy (73.7 mins), urologist mini-laparotomy (43.2 mins), and urologist laparoscopy (72.6 mins).
Early catheter dysfunction rates were comparable across modalities: fluoroscopic (7.04%), nephrologist mini-laparotomy (8.33%), urologist mini-laparotomy (7.14%), and urologist laparoscopy (5.88%). Exit site leakage was lower for fluoroscopic placement (4.23%) compared to nephrologist mini-laparotomy (8.33%) and urologist laparoscopy (11.76%).
Catheter survival rates at 180 days (fluoroscopic 88.1%, nephrologist mini-laparotomy 85%, urologist mini-laparotomy 94%, urologist laparoscopy 93.8%) and 365 days (fluoroscopic 88.2%, nephrologist mini-laparotomy 85%, urologist mini-laparotomy 80.49%, urologist laparoscopy 92.9%) were similar.
The program reduced acute haemodialysis sessions by 58.7%, from an average of 10.3 sessions (range: 2–24) to 4.25 sessions (range: 1–12).
Fluoroscopic-guided PD catheter placement, safely performed by nephrologists, demonstrates non-inferior outcomes in operating time, complication rates, and catheter survival. It has also significantly reduced the need for acute haemodialysis sessions, offering a sustainable alternative for PD catheter placement.
